Does Your Child Need a Space Maintainer?

It is a rare day in my pediatric dentistry and orthodontic practice when I do not think about having enough space available for permanent teeth to grow in and line up properly. There are two situations when we worry about space in kids’ mouths:

1.

Naturally crowded teeth

2.

Prematurely lost primary teeth

Crowding

If teeth are crowded, sometimes teeth must be extracted to make room for the others to line up. Usually braces are needed after all the permanent teeth erupt, but extractions make the orthodontic treatment easier. Before all the permanent teeth erupt, maintaining the remaining space can be very helpful. We use a space maintainer called a Lower Lingual Arch for lower teeth and either an Upper Palatal Arch or a Trans-Palatal Arch for upper teeth. These appliances will stay in place until the permanent teeth erupt.

Lost Primary Teeth

Adults need to have an artificial tooth made to replace missing permanent teeth because the teeth on the other jaw can over erupt and disrupt the jaw function. Children are growing so much and their adult teeth come in soon enough that this is usually not a problem for kids. An artificial molar is not needed to replace missing primary teeth, just maintaining the space.

The primary (baby or milk) teeth are important for chewing and biting and speaking and especially for holding open the space needed for the permanent adult teeth to grow in. If a front baby teeth goes missing, we do not lose space very much so we do not have to replace missing front teeth or even make a space maintainer. Luckily, a gap-toothed grin in a kid is much cuter than in an adult!

But when a primary back tooth molar is lost by infection or trauma, the gingival gum fibers and the angle of the jaws closing together make for a strong tendency for the adjacent teeth to move into the newly open space. In other words, the space for the permanent tooth will be lost.

While initially the loss of a primary tooth does not seem like such a terrible thing, the future consequences could be the loss of a permanent tooth, extensive and expensive orthodontic appliances, and even an uncomfortable bite that causes abnormal wear on the poorly positioned teeth.

To avoid these problems, we routinely make a small appliance that spans the gap to keep the space open. This is called a band–loop space maintainer. It is made with a metal orthodontic band soldered to a wire stretching across the missing tooth’s space.

If more than one tooth is missing, another way to save the space is to use an appliance that goes from a permanent tooth on one side to one on the other side of the mouth. These are called a lower lingual arch to replace bottom teeth or a transpalatal arch to replace upper teeth. Often a lower lingual arch or transpalatal arch can keep the room that remains or even press the teeth to gain space.

Taking care of a space maintainer is easy; just don’t play with them and keep them clean.

To summarize, there are several types of space maintainers:

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Band-loop space maintainers – the most common space maintainer, it is most useful for replacing a single tooth. They consist of a metal orthodontic band soldered to a wire that spans the missing tooth space.

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Lower lingual arches (LLA) – also very common, are used to hold space open for more than one missing tooth or to help keep the lower incisors straight. Bands are placed on molars on both sides of the mouth then a soldered wire extends, on the tongue side, from one side to the other, touching the front teeth.

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Upper lingual arches – these are just like the lower lingual arches but on the top. They also make nice retainers to help keep the upper incisors straight after early orthodontic treatment.

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Transpalatal arches – metal bands on molars connect to each other with a wire that goes directly across the top of the mouth. These are useful for keeping molars in position without getting in the way of the front teeth.

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Nance appliances – metal bands on upper molars are soldered to a wire that has a plastic pad touching the roof of the mouth (palate).

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W-arches – these have metal molar bands soldered to a wire that rests against the inside of the molars and a large loop across the palate. These are useful for widening the upper dental arch.

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Distal shoe space maintainers – these have a band around the tooth closest to the missing one. A bar extends back and digs into the gums to guide permanent tooth eruption. I avoid these whenever possible.

Each of these have different uses and each doctor has their favorites.

For more information, or if you'd like to schedule an appointment, please give us a call at 971-470-0045.

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Specializing in dentistry for infants, children, adolescents and special needs patients